- Elevance Health (Grand Prairie, TX)
- **Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The **Utilization Management Representative II** is responsible for managing incoming calls, including triage,… more
- CVS Health (Austin, TX)
- …to litigated claims . + Strong attention to detail and project management skills. + Experience overseeing and answering written discovery. + Ability to work ... **Position Summary** As a Product Liability Litigation Adjuster, Risk Management , you will be responsible for managing lawsuits and...activities. + Utilizing legal skills to oversee and manage claims against CVS from the initiation of suit through… more
- AIG (Dallas, TX)
- …of your technical expertise. Make your mark as a Forensic Analyst As a claims professional, you are respected for your deep accounting expertise. You balance the ... types to assist in the quantification and the measurement of commercial business insurance claims . + Work with a team and supervisors and be mentored during the… more
- Burns & McDonnell (Austin, TX)
- …downstream contract administration including request for information (RFI's), submittals, change management , contract closeout, and claims mitigation. + Other ... scope and fee development, staffing plan development, project oversight, quality management , and financial performance responsibilities. A major emphasis will be… more
- Pilgrim's (Mount Pleasant, TX)
- …require outside medical care to third part administrator (TPA), imitation of internal case management on workers' compensation claims . 6. Adhere to all state and ... nursing assessment, first aid, follow-up care, rehabilitation service, and case management . 5. Coordinate all workers' compensation management including,… more
- Public Consulting Group (Austin, TX)
- …through claim issue research. Additional this position will assist in performing claims processing, medical record audits for all implemented agencies, and assist ... and medical record reviews that will include discussion with internal management to ensure understanding of results. **Summary of Functions** The Contract… more
- Caris Life Sciences (Irving, TX)
- …future issues. + Identifying and communicating process errors to optimize revenue cycle management . + Utilize payor portals to gather claims status information. ... The Accounts Receivable Associate is responsible for reviewing outstanding denied claims with Medicare, Medicaid and Commercial insurance companies. This role… more
- Cardinal Health (Austin, TX)
- …their distribution channels, ensuring broader access to innovative therapies. + ** Claims Adjudication:** Oversee the claims adjudication process, ensuring timely ... and accurate processing of ATSP claims for CGT treatments. + **Compliance:** Ensure all contracting...with different health care stakeholder types) + Strong time management to enable prompt follow up to any payor… more
- Sedgwick (Dallas, TX)
- …General Adjuster - Southwest Region **PRIMARY PURPOSE** **:** To handle losses or claims nationally regardless of size, including having the ability to address any ... Account. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies, claims , and other records to determine insurance coverage. + Administers… more
- Humana (Austin, TX)
- …+ Provider contract interpretation experience + Previous account management or project management + Knowledge with medical claims + Ability to accommodate a ... provider relations to support customer service activities through data integrity management needed for service operations. The Network Operations Coordinator 4… more